Hip Dysplasia: Understanding This Common Joint Condition

It is also known as congenital hip dislocation. In this situation the head of the femur emerges from its socket in the pelvis.

Hip dysplasia refers to a broad spectrum of hip deformities that present in the newborn or develop during childhood and include:

• Hip joint dislocation;
• Subluxation: partial loss of normal contact between the femur and the pelvis;
• Dislocable hip: when by means of a manipulation we can dislocate the hip;
• Acetabular dysplasia - small abnormalities of the joint shape of the joint cavity.

Causes

It is caused by many factors. Congenital hip dislocation is more common in some families. Intrauterine posture during pregnancy plays an important role, as does breech presentation.

The risk factors for suffering from it are: first child, female sex, family history, breech presentation and other associated postural deformities of the feet or neck.

Diagnosis

In the examination of the newborn, congenital dislocation of the hip can be detected early using the Barlow and Ortolani maneuvers.

When suspected, an ultrasound of the hips should be performed. X-rays should be performed after six months of life, ultrasound is of no use.

Many newborns only have hip instability during the first weeks of life that disappears spontaneously.

Symptoms

Only hip dysplasias that have not been detected or treated in the first months of life will give symptoms in the older child.

In the older affected child, lameness is observed, one limb shorter than the other.

Treatment

The goal of treatment is to reposition the hip so that it develops normally without deformities.

Children with hip instability beyond the first three weeks of life or a complete dislocation should be treated. In a first phase, to reduce the hip, an abduction splint (Paulik or Tubingen) must be placed that keeps the hips open and the femur in place. In many cases this is the definitive treatment.

If the objective is not achieved in three weeks, a cast should be placed to immobilize the hip.

In children older than 18 months in whom an adequate result of the previous treatment has not been achieved, surgical treatment should be performed.

If the diagnosis and treatment are carried out during the first three months of life, the evolution is good and the child is left without sequelae.

The later the problem is detected, the more sequelae will remain in the child and the lameness will be permanent.